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� <br />Uate 10-14-92 <br />T� P�STIN�i_ MAR 0 5 i997 <br />Appiication For <br />PUBLIC WORKS PERMIT <br />Print or Type Only <br />VuO�ic Works Parm�t e <br />���"v <br />eiao o,oc. 3837 <br />Publit Works Fee <br />Ta1al Fee S <br />L¢sa ApP� Fee PaiE .S <br />Balance Due S � <br />Howard � Francis Lorentz 5804 Cady Rd Everett WA 89206 347-1446 <br />Owner MalNng Adtlress .� City �, � � Zip <br />Owner <br />Applicant Mailing Address City Zip Phone <br />Desc�ibe Proposed Work new huuse <br />Prolect Address (if known) <br />1033 Mukilteo Blvd <br />Attach four (4) copies of plans for proposed work • Draw lo scale and note the lollowing as applicabie: <br />• Property Lines • Centerline of street <br />• Outline and dimr.nsions of all existing and • Indicete North <br />proposed structures on the lot • Show any proposed grading changes <br />• Existing and proposed utilities • Show measurements <br />,�� <br />PERMIT CONDITIONS <br />1. All calls for inspection shall be made 24 hrs. in advance - phone 259•8810. <br />2. All work shell be peAormed in accordence with this permit an�i current City of Everett Design and Construction <br />Stendards and Specifications. <br />3. Cell Location Undergraund Service 48 hrs. before you dfg. TOLL FREE NUMBER 5-800-424•5555. <br />o- ��r�2 � <br />lpproved for Construction Date <br />/ <br />_/ �� �=�-�3 <br />INAL INSPECTION Date <br />pproved as Constructed <br />�PUBLICWORKSDEPARTMENT <br />3200 Cedar Straet <br />Everett. WA 98201 <br />� Phone:259•8810 <br />W <br />� <br />� <br />� <br />O <br />� <br />� <br />O <br />a <br />ACKNOWLEDGEMENT OF CONDITIONS <br />The undersigned owner/applicant hereby agrees to hold and save harm- <br />less the City of Everett Irom any and all claims for damages, costs, <br />expenses, or causes of action that may arise because of installation <br />and maintenance of the improvement or other right-ol-way use hereto <br />applied for and further agrees to remove sarne upon notice from the <br />City and to replace public property damaged thereby. <br />� <br />1 z c -� <br />Signature of Applicanl ate <br />WORK AUTHORIZED BY THIS PEFt IT MUST BE STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED AND THEREAFTER IS TO <br />BE DIL�GENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br />CANCELLED BY THE CITY UPON ANY STOPPAGE Of WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. � <br />